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The aim of this study was to evaluate the effect of total intravenous anesthesia (TIVA) and inhalational anesthesia techniques on tissue oxygenation in cardiac surgery. The primary objective of this study was to compare the effects of midazolam-based TIVA and sevoflurane-based (SEVO) inhalation anesthesia maintenance on intraoperative central and regional tissue oxygenation parameters.
A pressing issue in anesthesiology involves developing an understanding of the non-anesthetic effects of the medications typically used in intravenous and inhalation anesthesia methods. Few studies describe the effects of both intravenous and inhalational anesthetics on regional tissue perfusion is described under stable anesthetic conditions. There is the issue of whether inhalational anesthetics compromise regional tissue perfusion even though systemic parameters are within normal ranges. It is still debated how these effects may be different under pathophysiological conditions, such as cardiac surgery.
Maintaining tissue perfusion and oxygenation is the cornerstone of therapy for patients with cardiac disease. An imbalance in oxygen delivery and tissue oxygen consumption leads to anaerobic metabolism, cellular injury, and organ dysfunction, and is associated with poor outcomes. Consequently, monitoring tissue oxygen delivery and consumption status is of paramount importance in cardiac surgery patients. Routinely used monitors in intraoperative settings such as pulse oximetry, blood pressures, hemoglobin saturation levels, lactate, acid-base status, and central venous oxygen saturation levels all reflect tissue metabolism. Near-infrared spectroscopy (NIRS) is a non-invasive optical technique that can be used to continuously monitor tissue oxygen delivery and oxygen consumption status. Cerebral autoregulation can blunt the effect of impaired systemic oxygen delivery. Thus, cerebral NIRS may be a good predictor of neurological outcomes, but skeletal muscle NIRS serves as a follow-up indicator of many other postoperative complications due to impaired perfusion and oxygenation. Therefore, both cerebral and somatic monitoring may contribute to a more complete evaluation of hemodynamic competence. Obtaining the cerebral and somatic oxygenation levels are valuable to help in clinical management during cardiopulmonary bypass (CPB) and cardiac surgery as a whole.
The aim of this study was to evaluate the effect of total intravenous anesthesia (TIVA) and inhalational anesthesia techniques on tissue oxygenation in cardiac surgery. For this purpose, the effects of midazolam-based TIVA or sevoflurane-based inhalation anesthesia maintenance on intraoperative central and somatic tissue oxygenation parameters were compared in patients undergoing cardiac surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TIVA group | During the anesthesia maintenance of the TIVA group, 3 μg.kg-1 fentanyl, 0.01-0.05 mg.kg-1 midazolam, and 0.2 mg.kg-1 rocuronium bromide were applied throughout the operation to keep BIS between 40 and 60, approximately once every 45 minutes. |
| |
| SEVO group | During the anesthesia maintenance of the SEVO group, 2-3% sevoflurane (1-2 MAC), 3 μg.kg-1 fentanyl and 0.2 mg.kg-1 rocuronium bromide were applied throughout the operation to keep BIS between 40-60. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TIVA | Procedure | During the anesthesia maintenance of the TIVA group, 3 μg.kg-1 fentanyl, 0.01-0.05 mg.kg-1 midazolam, and 0.2 mg.kg-1 rocuronium bromide were applied throughout the operation to keep BIS between 40 and 60, approximately once every 45 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Hemodynamic parameters | mean arterial pressure in mmHg was recorded | 5 minutes after anesthesia induction |
| Hemodynamic parameters | heart rate (beat per minute) were recorded | 5 minutes after anesthesia induction |
| Hemodynamic parameters | mean arterial pressure (mmHg) was recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| Hemodynamic parameters | heart rate (beat per minute) was recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| Hemodynamic parameters | mean arterial pressure (mmHg) was recorded | 10th minute of cardiopulmonary bypass |
| Hemodynamic parameters | heart rate (beat per minute) was recorded | 10th minute of cardiopulmonary bypass |
| Hemodynamic parameters | mean arterial pressure (mmHg) was recorded | 10 minutes after cross clamp removal |
| Hemodynamic parameters | heart rate (beat per minute) was recorded | 10 minutes after cross clamp removal |
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Inclusion Criteria:
- coronary surgeries with CPB
Exclusion Criteria:
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adult patients who undergoing coronary surgeries with cardiopulmonary bypass
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara City Hospital | Ankara | Select State/Province | 06800 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19959497 | Result | Turek Z, Sykora R, Matejovic M, Cerny V. Anesthesia and the microcirculation. Semin Cardiothorac Vasc Anesth. 2009 Dec;13(4):249-58. doi: 10.1177/1089253209353134. Epub 2009 Dec 2. | |
| 27308951 | Result | Bickler P, Feiner J, Rollins M, Meng L. Tissue Oximetry and Clinical Outcomes. Anesth Analg. 2017 Jan;124(1):72-82. doi: 10.1213/ANE.0000000000001348. |
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| SEVO | Procedure | During the anesthesia maintenance of the SEVO group, 2-3% sevoflurane (1-2 MAC), 3 μg.kg-1 fentanyl and 0.2 mg.kg-1 rocuronium bromide were applied throughout the operation to keep BIS between 40-60. |
|
| Hemodynamic parameters | mean arterial pressure (mmHg) was recorded | 10 minutes after CPB completion |
| Hemodynamic parameters | heart rate (beat per minute ) was recorded | 10 minutes after CPB completion |
| Hemodynamic parameters | mean arterial pressure (mmHg) was recorded | upon sternum closing |
| Hemodynamic parameters | heart rate (beat per minute) was recorded | upon sternum closing |
| Arterial gas sampling | pH levels were recorded | 5 minutes after anesthesia induction |
| Arterial gas sampling | central venous saturation (%) levels were recorded | 5 minutes after anesthesia induction |
| Arterial gas sampling | lactate levels (mmol/L) were recorded | 5 minutes after anesthesia induction |
| Arterial gas sampling | Hemoglobin (g/dL) levels were recorded | 5 minutes after anesthesia induction |
| Arterial gas sampling | pH levels were recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| Arterial gas sampling | central venous saturation (%) levels were recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| Arterial gas sampling | lactate (mmol/L) levels were recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| Arterial gas sampling | hemoglobin (g/dL)levels were recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| Arterial gas sampling | pH levels were recorded | 10th minute of cardiopulmonary bypass |
| Arterial gas sampling | central venous saturation (%) levels were recorded | 10th minute of cardiopulmonary bypass |
| Arterial gas sampling | lactate (mmol/L) levels were recorded | 10th minute of cardiopulmonary bypass |
| Arterial gas sampling | hemoglobin (g/dL) levels were recorded | 10th minute of cardiopulmonary bypass |
| Arterial gas sampling | pH levels were recorded | 10 minutes after cross clamp removal |
| Arterial gas sampling | central venous saturation (%) levels were recorded | 10 minutes after cross clamp removal |
| Arterial gas sampling | lactate (mmol/L) levels were recorded | 10 minutes after cross clamp removal |
| Arterial gas sampling | hemoglobin (g/dL) levels were recorded | 10 minutes after cross clamp removal |
| Arterial gas sampling | pH levels were recorded | 10 minutes after CPB completion |
| Arterial gas sampling | central venous saturation (%) levels were recorded | 10 minutes after CPB completion |
| Arterial gas sampling | lactate (mmol/L) levels were recorded | 10 minutes after CPB completion |
| Arterial gas sampling | hemoglobin (g/dL) levels were recorded | 10 minutes after CPB completion |
| Arterial gas sampling | pH levels were recorded | upon sternum closing |
| Arterial gas sampling | central venous saturation (%) levels were recorded | upon sternum closing |
| Arterial gas sampling | lactate (mmol/L) levels were recorded | upon sternum closing |
| Arterial gas sampling | hemoglobin (g/dL) levels were recorded | upon sternum closing |
| NIRS | cerebral (rSO2) values were recorded | 5 minutes after anesthesia induction |
| NIRS | somatic (rSO2) values were recorded | 5 minutes after anesthesia induction |
| NIRS | cerebral (rSO2) values were recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| NIRS | somatic(rSO2) values were recorded | After cardiopulmonary bypass cannulation, an average of 5 minutes |
| NIRS | cerebral (rSO2) values were recorded | 10th minute of cardiopulmonary bypass |
| NIRS | somatic (rSO2) values were recorded | 10th minute of cardiopulmonary bypass |
| NIRS | cerebral (rSO2) were recorded | 10 minutes after cross clamp removal |
| NIRS | somatic (rSO2) were recorded | 10 minutes after cross clamp removal |
| NIRS | cerebral(rSO2)values were recorded | 10 minutes after CPB completion |
| NIRS | somatic (rSO2) values were recorded | 10 minutes after CPB completion |
| NIRS | cerebral(rSO2)values were recorded | upon sternum closing |
| NIRS | somatic (rSO2) values were recorded | upon sternum closing |
| 19853081 | Result | De Backer D, Dubois MJ, Schmartz D, Koch M, Ducart A, Barvais L, Vincent JL. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg. 2009 Nov;88(5):1396-403. doi: 10.1016/j.athoracsur.2009.07.002. |